Eating and drinking

Daily life

Introduction

My partner is so restless now that he can’t seem to sit and finish a meal. But he’s happy to take a sandwich and eat it as he goes.

I used to get so upset when my sister ate with her fingers in company. I used to try to make her use her fork and for a while I didn’t invite anyone round. But then I thought about it and I decided that it really didn’t do anyone any harm. She wasn’t worried and my friends all said they didn’t mind – it was just me being embarrassed. So I decided not to worry about it any more.

You may have found that mealtimes are becoming more and more difficult. Perhaps the person with dementia makes a mess eating and you need to help them handle knives and forks. This might irritate you or make you feel embarrassed in front of guests. You may find that they eat more often because they forget having eaten or that they forget to eat altogether. They might start to eat everything or just one thing. They might also be perturbed by the difficulties they are experiencing. They might feel embarrassed or frustrated at not being able to eat correctly and suffer from other problems such as constipation, forgetting to chew food and loss of or disturbance of their sense of taste. Eating and drinking can clearly be problematic for you both. However, there are a number of ways you can help the person to maintain a healthy diet and enjoy meals, whilst at the same time contributing to maintaining a certain level of independence.

How to cope with eating and drinking

Provide assistance, whilst encouraging independence

So as not to make the person with dementia feel like a child or embarrassed, it is best to encourage them to do as much as possible themselves. For example, if they cannot handle a knife, instead of spoon-feeding, you could prepare bite-sized pieces of food or cut it up before serving it. By changing the way to eat or serve food, you can leave the person with the chance to remain independent longer. Sometimes, a simple reminder (e.g. to use a spoon instead of a fork) may be all that is needed. It might help to have your own meal at the same time. However, at some stage, you may find that spoon-feeding is necessary. If this occurs, you should be careful not to try when the person is drowsy, agitated or lying down, as otherwise they could choke. Certain medication can lead to problems swallowing as food becomes lodged in the person’s mouth. If they have difficulty swallowing, the following guidelines might be useful to bear in mind.

Make sure that the person sits upright, keeps their chin down and takes small sips of drink. Avoid vessels which force the head back too much (specially designed cups and mugs exist). Alternate food and drink to help clear the mouth. Encourage the person to try to swallow each mouthful of food twice (e.g. to swallow a second time even if the mouth is empty). If they have not swallowed, it can be useful to present an empty spoon. Encourage frequent swallows to counteract dribbling. Avoid mixtures of liquid and solid food (e.g. certain soups or cornflakes), stringy textures (e.g. cabbage, runner beans); floppy textures (e.g. lettuce, cucumber) and small, hard textures (e.g. peanuts and sweet corn).

Making mealtimes a pleasant experience

As a result of these difficulties, the person with dementia may start to dislike mealtimes, seeing them as an ordeal rather than a pleasant experience. However, giving the person enough time to try to manage alone or a little assistance may help them to feel more relaxed. Background music might also help contribute to a relaxed atmosphere. They might not manage to eat without being slightly messy or untidy, but in this case, it is perhaps best not to draw attention to it, as it could make them less inclined to try. Finally, they might want to be more involved, e.g. help to prepare food or clear the table. Mealtimes provide an ideal opportunity to give the person with dementia the chance to remain active and feel useful.

How to prevent problems with eating and drinking

You may be able to prevent some problems from occurring, by taking certain precautions or slightly adapting the way you normally prepare food and serve it.

For example:

The routine : Give more time; serve plates of food instead of having self-service; remove condiments once used; have smaller meals more often if the person forgets having eaten; serve the main meal at midday to prevent night-time indigestion, etc.

The utensils and layout : Try to find out about specially designed utensils, non-breakable dishes, non-slip mats and drinking containers that cannot be knocked over; use mugs if possible for certain food as the ability to hold a mug tends to be retained longer than the ability to use a knife and fork; provide a sharp contrast between plates and the table and avoid strong patterns on table cloths as this can cause confusion.

The kind of food served : Prepare finger foods if the person has difficulty handling a knife and fork or is restless and cannot stay long at table; bite sized pieces avoid the need to use a knife; prepare food in a liquidiser rather than serving baby food if they cannot manage solid food so as to avoid embarrassment; avoid milk or citrus juice which tends to produce more mucus and can aggravate respiratory problems and drooling, if this is a problem.

Ensure a sufficient amount of liquid per day

It is important that you try to give the person with dementia enough to drink to avoid dehydration, constipation and more confusion. If possible, try to encourage them to drink 1½ litres (8 cups) of liquid per day. However, there are certain cases where even more attention needs to be taken, e.g. with people who have vomiting, diarrhoea or diabetes and people who are taking diuretics (water pills) or heart medication. On the more practical side, you will need to make sure that drinks are not too hot, as otherwise the person might scald themselves without realising. If they tend to become agitated, it is best to limit drinks which are stimulants (e.g. coffee, tea, hot chocolate, etc.). Possible alternatives include fruit and milk drinks, as well as decaffeinated drinks. Otherwise let them drink what they are used to.

Consult a doctor in case of loss of appetite

You should not worry too much if the person with dementia loses weight, as this can be a natural consequence of the disease. They might even be eating normally. However, it is nevertheless a good idea to contact your doctor just to check that there is not a physical cause and in case nutritional supplements should be given.